Provider Demographics
NPI:1336401611
Name:POSTON, JENNIFER ROSE (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:POSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 WASHINGTON ST
Mailing Address - Street 2:PO BOX 903
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1306
Mailing Address - Country:US
Mailing Address - Phone:660-646-3937
Mailing Address - Fax:660-646-4092
Practice Address - Street 1:1405 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633-1945
Practice Address - Country:US
Practice Address - Phone:660-542-1333
Practice Address - Fax:660-542-6015
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO47445042OtherBCBS KC
MO1336401611Medicaid
MO47445022OtherBCBS KC- BR
MO47445032OtherBCBS KC- CAR
MO47445012OtherBCBS KC- TR
MO47445032OtherBCBS KC- CAR
MO1336401611Medicaid
MOP01146976Medicare PIN
MO47445022OtherBCBS KC- BR
MO47445012OtherBCBS KC- TR
MO4637030002Medicare NSC
MO4637030005Medicare NSC